Approvals Group

New Zealand Food Safety

Ministry for Primary Industries
Charles Fergusson Building, 34-38 Bowen St, Pipitea
PO Box 2526, Wellington, New Zealand 6140 Tel: 04 894 2550
Email: approvals@mpi.govt.nz

Application Form FA10MSNP

New Multi-Site Food Business subject to a National Programme under Food Act 2014

Before you start, let’s check that you have everything you need:
 You are filling in this form because your business is a multi-site operation, so you need registration information
for every address where food is traded (see section 3). Multi-site means there is more than one address where
food is traded, and you would like to register all sites under one application. A spreadsheet of the sites’
information attached to your application is acceptable.
 A description of your business scope of operations. Find more information and a form to fill in by visiting
www.mpi.govt.nz/food-safety/food-act-2014/, Forms & templates, Scope of Operations.
 A copy of the confirmation letter from your verifier. A list of recognised verification agencies can be found here:
www.mpi.govt.nz/food-safety/food-act-2014/, Registers & lists.
 If your business is a registered limited liability company, a copy of the company registration certificate and
your New Zealand Business Number (NZBN). See www.companies.govt.nz
 If you were registered with either MPI or your local council before 1 March 2016, make sure you have your
previous registration IDs on hand. These are IDs such as FSA-JBIP-12345 or WEBB-12345.
 Your application fee of $116.44 (incl. GST).

Read these notes before you start filling out the form
 This form must be used when applying to MPI for registration of a business under a national programme under
section 83 of the Food Act 2014. Some information provided will be included on the public register; however,
you can ask for certain personal information to be withheld from the published register. We will tell you where
you can choose that option. You can view the public register here: www.mpi.govt.nz/food-safety/food-act-2014/,
Registers & lists.
 Send the completed application form together with the fee and other requirements above to MPI at the above
address. We prefer email files. Processing time is up to 20 working days from the time we determine that
your application is complete.

 This icon is used when you need to make a decision. The question will help you decide whether you need
to complete a particular section.
 Throughout this form you will need to tick boxes that look like this: . A checked box indicates a ‘yes’ answer.

 If there are any changes to the details provided in this application after the application has been sent to MPI,
you must promptly inform us of the changes in writing.
Approvals Group
New Zealand Food Safety
Ministry for Primary Industries
Charles Fergusson Building, 34-38 Bowen St, Pipitea
PO Box 2526, Wellington, New Zealand 6140 Tel: 04 894 2550
Email: approvals@mpi.govt.nz

Application Form FA10MSNP

New Multi-Site Food Business under National Programme under Food Act
2014
Processing time is up to 20 working days from the time we determine that your application is complete.

What type of registration are you applying for?

Tick one. If you want to register under more than one national programme level, you will need to submit an application for each, or register
under the highest level. Visit the MPI website “Where Do I Fit” to find out which type of registration you need.

National Programme Level 3

National Programme Level 2
National Programme Level 1

Prior to 1 March 2016, were you registered as a food business with MPI or your
local council?

Yes  Complete section 1.

No  Go straight to section 2.

1. Previous registration IDs

If you were registered as a food business with MPI or your local council before 1 March 2016, enter your current registration ID number or
numbers.

Any previous registration ID nu mber(s), e.g. FSA-JBIP-12345 or WEBB-12345. Add additional lines if necessary.

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

2. Operator Details
Enter the details of the person who is either the owner or person in control of the food business.
Legal Name(s) of
Operator
(e.g. registered
company, partnership I have attached a copy of the company name registration from the New Zealand Companies office
or individual) (www.companies.govt.nz)

New Zealand Business

Number (NZBN)
For more information about NZBN’s, including how to get one, see www.nzbn.govt.nz

Trading Name, if any

(i.e. ‘Trading As’)
Same as legal name above
Operator Address and Contact Details
You must provide this information to be registered. However, if the address is a dwellinghouse, you may ask that the address is withheld
from the public register by ticking the box below.

Postal Address Physical / Courier Address (if different to Postal Address)

Address: Address:

Town/City: Town/City:
Postcode: Postcode:
Country: Country: New Zealand
This address is a private dwelling/house and I wish it to This address is a private dwelling/house and I wish it to
be withheld from the public register. be withheld from the public register.
Contact Person Details
The contact person details entered below will be used for communications, such as sending approval documents and renewal reminders.
Contact MPI if the details change.

Mobile telephone no. Other

telephone
no.

Email

By entering an email address you consent to being sent information and notifications electronically, if required.

Operator day-to-day Name:

manager name and
position Position:

3. Verification Agency details

Name of Verification Agency(ies)
MPI may contact your Verification Agency
directly to clarify any issues related to your
registration I have attached a copy of the letter confirming my nominated Verification Agency(ies)
will provide verification services for my registration.

4. Scope of Operations
Tick one. Scope of Operations tells us more about what you do. A Scope of Operations form is available online
at www.mpi.govt.nz/food-safety/food-act-2014/, Forms & templates.

I have attached a completed Scope of Operations form providing a description of my business operations; or,

I have attached a written description of my business operations. This includes all of the following:
- the Food Act sectors I will operate in – for example, retail, food service, manufacturing
- my products – the type of food I will make or sell
- processes – how I will make my food
- trading operations – how and where I will sell my products

November 2020 Page 3 of 6 FA10MSNP: Multi-Site National Programme

5. Multiple Address Details
Add extra rows as necessary or attach a file (e.g. spreadsheet) to your application email with all of the information required below. Include all addresses where food is handled that come under this registration. If you already included a
food handling site address in section 2, repeat it here.

Site trading name, if any (i.e. ‘Trading As’): Street/Physical Address (location of actual place) Vehicle Registration Site day-to-day Local
(Tick box if you wish the address to be withheld from the public register numbers (mobile manager position Council
because it is a private dwellinghouse) businesses only)
E.g. Yummy CakesRUs, Wellington Store E.g. 123 Cakes Road, Faketown 1234 E.g. Store
✔ Manager

November 2020 Page 4 of 6 FA10MSNP: Multi-Site National Programme

6. Applicant Statement
Complete for all applications. We accept PDF or scanned versions of signatures.

I confirm that:
1. I am authorised to make this application as the operator or a person with legal authority to act on behalf of the operator; and

2. The information supplied in this application is truthful and accurate to the best of my knowledge and belief; and

3. The operator is resident in New Zealand within the meaning of section YD 1 or YD 2 (excluding section YD 2(2)) of the Income
Tax Act 2007; and

4. The operator of the food business is able to comply with the requirements of the Food Act 2014.

Name Job Title

Signature Date

7. MPI Service Charge

ON PAYMENT THIS BECOMES A TAX INVOICE GST No: 64-558-838

Tick (all fees include GST)

Registration under National Programme 0.75 hours $116.44

Note: In addition to the application fee above, an assessment time fee based on an hourly rate of $155.25 (incl. GST) per hour or $38.81
(incl. GST) per 15 minutes may be charged in instances where applications take longer to process.
PAYMENT OPTIONS: Payments comprising multiple fees must be supported by a remittance advice. Please attach your advice to this
application or send it separately to: MPI Approvals, PO Box 2526, Wellington 6140.
MPI does not accept cash. Payment must be made using one of the following methods. Please tick and fill in the appropriate section.
DIRECT CREDIT:
1. Pay into Bank Account no. 03 0049 0001709 002
2. In the ‘Reference’ details, put the code: ‘Food Act {your trading name}’
3. Enter the date of deposit and your name (payee) below.

Date of Deposit Your Name (Payee)

CREDIT CARD:
1. To pay by credit card (Visa or MasterCard) go to https://www.mpi.govt.nz/food-safety/payments and follow the instructions.

November 2020 Page 5 of 6 FA10MSNP: Multi-Site National Programme

 8. Final Check and Document Package to send to MPI

Have you:
filled this form in completely and legibly?
attached a letter from your verification agency?
attached a copy of company registration certificate if you are a registered limited liability
company?
attached a description of your scope of operations?
read and signed the Applicant Statement?
included fee payment for this application?

Collection of Information

Collection of Personal Information

Pursuant to Principle 3 of the Privacy Act 2020, we advise that:
 This information is being collected for the purpose of registering under the Food Act
2014; and
 The recipient of this information, which is the agency that will collect and hold the
information, is MPI, PO Box 2526, Wellington 6140; and
 Some of the information collected will be displayed on a public register; and
 The collection of information is authorised under section 83 of the Food Act 2014. The
provision of this information is necessary in order to process an application for
registration under either section 83; and
 The supply of this information is voluntary; however, failure to provide the requested
information is likely to result in a return of this application form, and may ultimately result
in a refusal to register, in accordance with section 84 and 87 of the Food Act 2014; and
 Under Principles 6 and 7 of the Privacy Act 2020, you have the right of access to, and
correction of, any personal information that you have provided.

Collection of Official Information

All information provided to MPI is official information and may be subject to a request
made under the Official Information Act 1982.
If a request is made under that Act for information you have provided in this application, MPI
must consider any such request in accordance with its obligations under the Official
Information Act 1982 and any other applicable legislation.

November 2020 Page 6 of 6 FA10MSNP: Multi-Site National Programme